Lyme Disease NYC

Lyme Disease

Lyme disease is caused by the bacterium Borrelia burgdorferi and is
transmitted to humans by the bite of infected blacklegged ticks.

Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If
left untreated, the infection can spread to joints, the heart, and the nervous system.

Lyme disease is diagnosed
based on symptoms, physical findings (such as a rash), and the possibility of exposure to infected ticks; laboratory testing
is helpful in the later stages of disease.

Most cases of Lyme disease can be treated successfully with a few weeks
of antibiotics. Steps to prevent Lyme disease include using insect repellent, removing ticks promptly, landscaping, and integrated
pest management.

The ticks that transmit Lyme disease can occasionally transmit other tick-borne diseases as well.

What Does the Rash of Lyme Disease (Erythema Migrans) Look Like?

A key component of early diagnosis
is recognition of the characteristic Lyme disease rash called erythema migrans (EM). This develops at the site of the tick
bite in about 80% of Lyme disease patients about 3 to 30 days following the tick bite.

Typically, the rash expands over a period of several days, reaching up to 12 inches (30 cm) across. The center
of the rash may clear as it enlarges, resulting in a bull's-eye appearance. It may be warm but is not usually painful.
Some patients develop additional EM lesions in other areas of the body after several days. Patients also experience symptoms
of fatigue, chills, fever, headache, and muscle and joint aches, and swollen lymph nodes. In some cases, these may be the
only symptoms of infection.

What Are the Symptoms of Lyme Disease?

Lyme disease
can infect several parts of the body, producing different symptoms at different times. Not all patients with Lyme disease
will have all symptoms, and many of the symptoms can occur with other diseases as well. If you think you may have Lyme
disease, it is important that you consult your doctor as soon as possible for proper diagnosis.

Most cases of Lyme
disease can be cured with antibiotics, especially if treatment is begun early in the course of illness. However, a small percentage
of people with Lyme disease have symptoms that last months to years after treatment with antibiotics. These symptoms can include
muscle and joint pains, arthritis, cognitive defects, sleep disturbance, or fatigue. The cause of these symptoms is not known.
There is some evidence that they result from an autoimmune response, in which a person's immune system continues to respond
even after the infection has been cleared.

Treatment

The National Institutes of
Health (NIH) has funded several studies on the treatment of Lyme disease. These studies have shown that most patients can
be cured with a few weeks of antibiotics taken by mouth. Commonly used oral antibiotics include doxycycline, amoxicillin,
or cefuroxime axetil.

People with certain neurological or cardiac forms of illness may require intravenous antibiotics
such as ceftriaxone or penicillin.

People treated with antibiotics in the early stages of the infection usually
recover rapidly and completely. People in later stages of disease may have persistent or recurrent symptoms. These patients
may benefit from a second 4-week course of therapy. Longer courses of antibiotic treatment are not recommended.

Studies
of women infected during pregnancy have found that there are no negative effects on the fetus if the mother receives appropriate
antibiotic treatment for her Lyme disease. In general, treatment for pregnant women is similar to that for non-pregnant persons,
although certain antibiotics are not used because they may affect the fetus. If in doubt, discuss treatment options with your
health care provider.

How Can I Avoid Getting Lyme Disease?

Be careful in areas
with a lot of ticks:

Ticks prefer wooded and bushy areas with high grass and a lot of leaf litter. These are areas
to avoid.

Take extra precautions in May, June, and July. This is when ticks that transmit Lyme disease are most active.

If you do enter a tick area, walk in the center of the trail to avoid contact with overgrown grass, brush, and leaf
litter.

Ask your local health department and park or extension service about tick-infested areas to avoid.

Permethrin is another type of repellent. It can be purchased at outdoor equipment stores that carry camping or hunting
gear. It kills ticks on contact. One application to pants, socks, and shoes typically stays effective through several washings.
Permethrin should not be applied directly to skin. Learn more at the National Pesticide Information Center.

Wear
long pants, long sleeves, and long socks to keep ticks off your skin. Wear light-colored clothing to help you spot ticks more
easily. Tuck pant legs into socks or boots and tuck shirts into pants to help keep ticks on the outside of clothing. If you’ll
be outside for an extended period of time, tape the area where your pants and socks meet to prevent ticks from crawling under
your clothes.

Check your skin and clothes for ticks every day!

Remove ticks from your clothes before
going indoors. To kill ticks that you may have missed, wash your clothes with hot water and dry them using high heat for at
least one hour.

Perform daily tick checks after being outdoors, even in your own yard. Inspect all parts of your
body carefully including your armpits, scalp, and groin. Remove ticks immediately using fine-tipped tweezers.

If
a tick is attached to your skin for less than 24 hours, your chance of getting Lyme disease is extremely small. But just to
be safe, monitor your health closely after a tick bite and be alert for any signs and symptoms of tick-borne illness.

Reference:
Centers for Disease Control

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This
information is for general educational uses only. It may not apply to you and your specific medical needs. This information
should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.
Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be
sure to follow specific instructions given to you by your physician or health care professional.

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Sun Protection

Ultraviolet radiation is the major cause of skin cancer, including melanoma. It is important
for everyone to be aware of its damaging effects and take measures to avoid overexposure.

Although many people enjoy
the appearance of tanned skin and think it looks "healthy," tanned skin is damaged skin. The ultraviolet radiation
in sunlight penetrates the deepest layers of the skin where it harms the cells. The body responds by making more pigment (melanin)
to try to protect itself, but the damage has already happened and may be permanent. The more exposure you have to the sun,
the more likely you are to develop skin problems later in life.

Ultraviolet Radiation

The damaging part of sunlight
is called ultraviolet radiation, or UV rays. It is categorized into three types:

UVC rays
(wavelengths = 200 nm to 290 nm) are the shortest and most powerful of the UV rays. UVC is
the most likely to cause cancer if it reaches skin. Fortunately, most of it is absorbed by the ozone layer in our atmosphere.
However, there is concern that a thinning of the ozone layer may be causing more UVC to reach the earth's surface.

UVB
rays (wavelengths = 290 nm to 320 nm) are less damaging than UVC, but more of it penetrates to the earth's surface.
It is the most common cause of sunburn and skin cancer. UVB is particularly strong at the equator, at high elevations, and
during the summer.

UVA rays (wavelengths = 320 nm to 400 nm)
are the least powerful of the UV rays, but they are present all year and can penetrate
windows and clouds.

Sun Protection

The first and more effective way to avoid sun damage is
to stay out of tthe sun as much as possible.

If you cannot avoid being exposed to sunlight,
there are five basic defenses that you should keep in mind when you go outdoors:

Avoid
peak hours of sunlight

Sunscreen

Clothing

Sunglasses

Shade

Avoid Peak Hours of Sunlight (UV Index)

In general, UV rays are the greatest between 10 a.m. and 4 p.m.
It is best to avoid the outdoors during these hours without protection, particularly during summer, in tropical regions, or
at altitude. During this time, you should pay close attention to the appropriate use of sunscreen, clothing, sunglasses, and
shade.

You can obtain an accurate measure of the amount of UV rays in your area by looking
up the Ultraviolet (UV) Index. The UV Index is like a weather forecast. It provides a
report on the amount of damaging UV rays that are expected to affect a region on a particular day. The UV Index changes day
to day according to time of year, cloud cover, atmospheric ozone, and other factors.

The following table is a breakdown
of the UV Index. A high UV Index number means that you are at greater risk of being exposed to ultraviolet radiation. You
should take special care to avoid outdoor exposure to sunlight when the UV Index is moderate or greater.

0 to 2
= Minimal

3 to 4 = Low

5 to 6 = Moderate

7 to 9 = High

10
or more = Very high

The UV Index can be found on our Website or in local
papers, usually in the weather section.

Sunscreen

There are several factors to consider when selecting the right
sunscreen. (See the Sunscreens handout for more information.)

Sun protection
actor (SPF) - Sunscreens are rated by the amount of protection they provide from UVB, measured as the "sun
protection factor" or SPF. Sunscreens with higher SPF provide greater protection from the sun. It is best to use sunscreens
that offer a minimum SPF of 15.

Broad-spectrum sunscreens - It is best to use a sunscreen that can
protect you from both UVA and UVB rays. These are called "broad-spectrum" sunscreens.
Most of the original sunscreens blocked only UVB, but increased awareness of the damage caused by UVA has lead to the
development of ingredients that protect against UVA too. Broad-spectrum sunscreens combine ingredients to provide a product
with greater protection.

Common sunscreen ingredients that provide protection
from UVB rays:

Cinnamates

Octocrylene

PABA (para-aminobenzoic
acid)

Padimate O and Padimate A (Octyl Dimethyl PABA)

Salicylates

Common
sunscreen ingredients that provide protection from UVA rays:

Avobenzone (Parsol 1789)

Benzophenones
(oxybenzone, dioxybenzone, sulisobenzone)

Sunblocks - "Physical"
sunscreen ingredients lie on top of the skin and work by reflecting or scattering UV radiation. They are particularly useful
for people who are sensitive to the ingredients found in other sunscreens. Sunblocks often contain one or more of these ingredients:

Zinc
oxide

Titanium dioxide

Iron oxide

Although past formulations
were unsightly (often leaving a white film on the skin), newer "microfine" formulations are invisible after being
applied. Microfine titanium dioxide is effective at protecting from both UVA and UVB rays.

Water resistance
- Sunscreens are classified as "water-resistant" if they maintain their protection after two 20-minute
immersions in water. They are classified as "waterproof" if they maintain their protection after four 20-minute
immersions. You should seek a water-resistant or waterproof sunscreen if you will be participating in water sports, such as
swimming or water skiing, or will be actively sweating.

However, independent testing has shown many products do not
perform well in the real world. So it remains a good idea to apply sunscreen every time you leave the water, or frequently
if you are actively sweating.

Using a Sunscreen

Sunscreen should be applied
evenly and liberally on all sun-exposed skin within 30 minutes before going outside to give sunscreen time to take effect.
(Sunblocks are effective immediately after being applied.) Sunscreens should be reapplied every two hours or following swimming
or sweating. Apply sunscreen generously and reapply frequently at least every two hours.

The chemicals may lose
effectiveness over time, so it is important to throw away sunscreen that is past its expiration date
or is over two years old.

No sunscreen is 100% effective; take additional measures to avoid the
damaging effects of the sun's rays.

Clothing

Clothing can provide excellent
protection from the sun. However, not all clothing is protective. A thin, wet, white t-shirt will provide almost no protection
from UV rays. When selecting clothes for sun protection, consider the following:

Cover your head, shoulders, arms,
legs, and feet.

Use a hat that is broad-brimmed (brim should be at least four
inches wide).

Wear fabrics that are thicker or with a tight weave; these allow less
sunlight to penetrate the skin.

Wear darker-colored clothes that absorb more UV rays.

Wear clothing
made from nylon or Dacron because it is more protective than cotton.

Avoid remaining
in wet clothes because wet fabric may allow more UV rays to penetrate the skin.

Wash
clothing with chemical absorbers to increase their protectiveness.

Some clothing
comes with a UPF rating that stands for "Ultraviolet Protection Factor." This measures the ability of the fabric
to block UV radiation from penetrating to the skin. A fabric with a UPF 15 allows only 1/15th (6.66%) of the UV radiation
to penetrate your skin as compared to uncovered skin.

Garments fall into 3 categories:

Good
protection: UPF = 15 to 24

Very good protection: UPF = 25 to 39

Excellent
protection: UPF = 40 to 50+

Choose clothing with a UPF rating of at least 15. Keep in mind that the UPF of a
garment will decrease over time as the fabric wears.

Sunglasses

Overexposure to sunlight can cause cataracts
and macular degeneration, a major cause of blindness. Sunglasses can provide protection. However, not all sunglasses are of
value. A darker lens itself does not guarantee protection. Look at the label to ensure that the glasses provide UV protection.
Sunglasses should be large enough to shield your eyes from many angles. Look for sunglasses that are described as blocking
99% or 100% of UVA and UVB. The glasses may also be described as providing UV absorption up to 400 nm.

Shade

If
possible, remain in the shade when outdoors. Keep in mind that shade does not provide full protection from the sun because
UV rays can bounce off reflective surfaces, such as sand, snow, water, concrete, or even porch decks. In addition, some fabrics
used as shade devices, such as parasols or umbrellas, may not provide sufficient protection. If you seek shade under a cloth,
look for a fabric that is thick, tightly woven, and dark-colored.

Clear window glass provides protection from UVC and
UVB, but not UVA rays. If you are frequently exposed to sunlight while driving, the plastic interleaf of your windshield (which
prevents it from shattering) can help block the light, but side windows have no such protection. Non-drivers can make use
of additional window shade devices. Drivers in some states may be able to use darkly-tinted glass in the side windows, but
this is illegal in some states.

Summary

Avoid the sun when its
UV rays are strongest, between 10 a.m. and 4 p.m.

Use a broad-spectrum sunscreen with SPF 15 or greater.
Apply it 30 minutes prior to being exposed to the sun and reapply every two hours. Consider using a water-resistant sunscreen
if you will be active (sweating) or in the water.

Use a sunblock on your lips.

Wear a broad-brimmed hat
when outdoors.

Wear sunglasses.

Wear tightly woven, dark clothing to
cover your arms, legs, and feet.

Stay in the shade when possible.

Avoid
reflective surfaces, such as water or snow.

Avoid sunbathing.

Don't
be fooled by cloudy days since damaging rays can penetrate clouds.